The Social Security Administration expects Indian men to live until 84 and Indian women to age 88, however, the tough part is getting to age 65 first.
Frank and Janice Martinez, a married couple in their 60s, were preparing for battle on a warm spring day. Seated, the couple extended their legs, bending themselves nearly in half with stretching exercises. They then joined four other silver-haired warriors at the starting line for the 25-yard dash. Janice Martinez won handily — in fact, she won several gold medals at the 2007 Senior Games, held during the Arizona Indian Aging Conference in April.
Janice, who is from a New York state tribe and Frank, a Fort McDowell Yavapai, are part of a little-known phenomenon in Arizona. If they can manage to avoid diabetes, heart or circulatory disease and accidents, they can expect to live another 20 healthy years — the longest life expectancy of any group in the state, or for that matter, in the country.
The growing population of American Indian elders in Arizona is also creating a new challenge for tribes already dealing with insufficient resources and misunderstanding by state officials.
The Social Security Administration notes on its Web site that American Indians tend to have higher life expectancies at age 65 than most U.S. citizens. American Indian men who reached age 65 in 2005 can expect to live to age 84, compared to age 81 for all men. American Indian women who became 65 in 2005 can expect to live to age 88, compared to age 85 for all women.
The journal Geriatric Times notes that between 1980 and 1998, the American Indian and Alaska Native population aged 65 and older increased by 33 percent, compared to an increase of nine percent in white seniors. The American Community Survey, conducted yearly by the U.S. Census Bureau reported that in 2005, nearly 16,700 people reporting only American Indian ancestry live in Arizona.
The growth in the native elder population is especially intriguing when considering that Indians have a very low overall life expectancy. The Arizona Department of Health Services reports that the average life expectancy for an American Indian is just 59, compared to 77 for the state as a whole.
Why the inconsistency?
One reason could be the causes of death in tribal communities. American Indians suffer from the highest accidental death rates in the state if not the nation; ADHS statistics note that young natives aged 20 to 44 have a 147 percent higher death rate than average. Rampant diabetes and high rates of alcoholism, which have ravaged many tribal communities, also factor in lower life expectancy.
So why do Indians live longer?
One reason could be that elders continue to play a vital role in their communities. All tribes in Arizona cherish and honor their elders. During community functions, elders are always served first. Elder centers provide places for elders to have meals together, do crafts and visit.
Elder councils help develop policy for elder services and serve as advisers to tribal councils. At one meeting with Fort McDowell elders, President Raphael Bear noted that he does listen to elders’ concerns, and assiduously took notes to address their concerns.
Laverne Wiaco, director of the Navajo Nation Aging Program, says that it may also be tribal elders’ active lifestyle. “Keeping active keeps them healthy longer,” says Wiaco. “They choose to stay at home.”
Indeed, many Navajo elders live alone in remote camps, where they keep busy caring for livestock, chopping wood for cooking and heating their homes and caring for grandchildren and great-grandchildren. There’s also a trend noticed by Wiaco and other Navajo government officials: Navajos who retire from careers in the government or private sectors give their modern homes away to their kids and “head back to the sheep camp.”
Workers bring in elders for meals, health checkups and to access Social Security and Medicare. “They like to come get meals,” says Wiaco. “But they want more traditional food like mutton.” Elders also don’t like to stay long in town. “They want to get home to get their chores done.”
Roadblocks to Navajo elder services
Of course, the remoteness of the elders’ homes is one of Wiaco’s biggest headaches in providing services to 36,000 Navajo elders on the 12 million acre reservation, incorporating portions of Arizona, Utah and New Mexico. “Transportation is my biggest issue,” she says. “Getting to these remote locations is a challenge.” Many Navajo elders don’t have any transportation other than walking, and Wiaco says it’s not unusual to wear out a van within a year due to wear and tear and mileage. “Our new van logged over 100,000 miles in a year,” she says.
And figuring out where to find elders—and getting them out—can also be a problem: “We don’t have signs out here,” says Wiaco, “just dirt roads,” which makes passage impossible when rain or snow falls on the bare dirt ruts.
Communication also poses difficulties. “Not all people on the reservation have phones,” Wiaco says. “And I wish there was a way we could get the Internet on the reservation.” Wiaco says she tried to put together a telemedicine program but with no modern telecommunications capacity, it never got off the ground. “We don’t have the technology here to get it going; we’re stuck with 1970s technology,” she sighs. “A lot of preventive care could be provided via the Net.” As a result, Wiaco says she can only provide services to half of the elders.
Wiaco also oversees efforts to work with federal and state programs serving elders. In a community where many elders don’t speak English or possess birth certificates, or who married in the traditional way and don’t have marriage certificates, just accessing services can be extremely difficult. Wiaco’s office is coordinating with Social Security, Arizona Long Term Care System, AHCCCS, Medicare and the Indian Health Service to ensure that elders get services. “My boss, Anselm Roanhorse, is making [documentation] a national issue,” says Wiaco. “We’re bringing it to the attention of Washington, as well as to the state level.”
Keeping elders at home also means making their homes safe, or even habitable. “We have all these trailers scattered throughout the reservation,” says Wiaco. “They’re overcrowded and aren’t safe; they deteriorate early.”
Navajo officials formed a partnership with AARP to perform rehabilitation on the structures, but it’s a slow process. “I wish it was on a larger scale,” says Wiaco.
Fred Hubbard, the new executive director of the Advisory Council on Indian Health Care and a former member of the Tribal Technical Advisory Group for the Centers for Medicare and Medicaid Services, once headed the White Mountain Apache Tribe’s health program. Hubbard, a Navajo, struggled with funding and misperceptions on the part of state officials while working for the tribe. He’s using his new position on the advisory council to address these issues.
Shelved Green House program showed promising results
One of Hubbard’s biggest issues was providing quality skilled care for elders who stay home when their adult children leave the reservation for work. For years, he tried to obtain funding for a groundbreaking new concept in senior nursing care called the Green House. In this model, seniors needing skilled nursing care are housed in a home atmosphere instead of the “military-style” nursing home model, says Hubbard.
The plan specifies no more than 10 residents live in the home, and each senior has a private room. One or two people provide care, including cooking, bathing and other skilled care. Residents arise when they want, instead of being roused all at once. Meals are cooked to order. Every home features a hearth room with a fireplace, a barber and hairdresser shop, laundry “where you can do your own if you want,” and even a patio with a grill for cookouts.
The six pilot Green Houses in Tupelo, Miss., reported near-miraculous results with residents, says Hubbard. “One lady, whose son had to help her eat, grabbed the spoon at the first meal in the home,” he says. “Another lady could no longer talk, but within two weeks in the Green House was trying to sing. It’s all part of being an individual again.”
The concept is ideal for Native communities and cultures, says Hubbard. Yet at the time, he could not get a dime to make the concept a reality in Whiteriver. “We went everywhere,” including the Health Care Financing Administration, known as HCFA, and the Arizona State Legislature for funding, only to be turned down, says Hubbard.
So today, instead of being allowed to live in their homeland with dignity, Apache elders who are unable to live on their own are shunted off to remote nursing homes, where care providers don’t understand their culture or language.
“[Former WMAT Chairman] Dallas Massey went to visit his father in the nursing home where he had been taken,” says Hubbard. “When he got there, he found his father in his room, tied to his bed and with the door closed.” When Massey investigated, he was told by nurses that his father was being combative and loud. “All he wanted was water,” says Hubbard. “He was asking for water in Apache.”
Hubbard once removed another Apache elder from a South Mountain facility. “He was just curled up in bed,” says Hubbard. “All I saw living there were black residents and one lone Apache.”
When the van reached Globe, “he started talking,” says Hubbard. “He knew he was going home. He was regaining life.”
Apache elders suffering from health problems actually run and hide when community health workers come to check on them, says Hubbard. “They know they’re going to be sent off to a home.” However, if they don’t get the care they need, “They deteriorate even more,” says Hubbard, “they should be home.”
Arizona tribes: ‘Haves’ versus the ‘have nots’
Although all tribes have elder programs or agencies, those with casinos can supplement their federal, state and grant funds and can do much more for their elders. For example, the Gila River and Salt River Indian communities are currently constructing elder housing. The Yavapai-Apache Nation in Camp Verde is also building an elder housing complex, composed of smaller duplexes close by one another, so elders can be close together for socializing.
Fort McDowell’s elders frequently take trips together to conferences and to visit with other elders. In 2006, Yavapai youths raised their own money to landscape the grounds around Fort McDowell elders’ center. Health care for seniors is also far better in tribes with casinos than their non-gaming neighbors, which helps tribal elders stay healthier and live longer, more productive lives. A physical trainer makes regular visits to the elders’ center to conduct exercise classes.
Meanwhile, tribes with few or even no gaming dollars, such as the White Mountain, Navajo and Hopi tribes, are working with state health care providers such as AHCCCS and ALTCS to gain greater access to services. These agencies, as well as Arizona Department of Health Services, Arizona Department of Economic Security and other state agencies employ tribal liaisons who help coordinate service provisions.
Don’t the Feds take care of all Indian needs?
However, tribal health departments still encounter barriers in working with the state. Every session, legislators introduce bills to appropriate state funds for senior centers and nursing homes in tribal communities, and most sessions, the bills never receive a hearing, much less make it through the full Legislature. This year, District 2 Democrats Reps. Albert Tom and Ann Kirkpatrick and Sen. Albert Hale introduced senior center and technology appropriations bills, none of which received a hearing.
“There’s a perception on the part of state officials that ‘Indians don’t pay taxes,’ and that the federal government takes care of all the needs of Indians,” says Hubbard. That perception couldn’t be further from the truth, though, he says. “Indians do pay many taxes,” including federal income, Social Security and other payroll taxes, Hubbard notes. And the federal government routinely shorts funding for tribal health and social services; Indian Health Service funding currently meets just 60 percent of the actual need nationwide.
Social Security also helps elders who can expect to live two decades past retirement age to access services. The Social Security Administration has hired a number of Native American outreach specialists such as Kimberly Irwin, a Rosebud Sioux who’s based in Mesa. Irwin says that it’s more than just outreach: “We need to be sensitive to our elders’ cultural beliefs,” says Irwin, who helps educate recipients on how to apply for services or appeal denied benefit determinations. “We also need to ensure that everybody who is eligible for services receives them.”
Social Security is especially important to Native elders: Social Security reports that nationwide, 38 percent of elderly married Native American couples and 61 percent of elderly unmarried Native Americans receiving SSA benefits rely on Social Security for 90 percent or more of their income.
Elder care services such as adult day care are almost non-existent in tribal communities, and on-reservation long term care is a precious commodity when basic health care is still rationed, as National Council on Indian Aging Executive Director Tracy McClellan points out.
However, providing good preventive care for seniors saves taxpayers money, says Hubbard. “When an elder goes into tertiary care [which may include expensive surgeries and hospital stays], who pays? We all do.”
In his new job with the Advisory Council on Indian Health Care, Hubbard says he’s amazed at the variety of resources that don’t reach tribal people. “It doesn’t get communicated or gets sent to the wrong level,” he says. “Because of that, a lot doesn’t happen.”
Hubbard says that many of the answers to Native elder care lie in a rural health plan developed by the University of Arizona’s Mel and Enid Zuckerman College of Public Health in 2004. “The plan [which Hubbard helped develop] was good but then it just disappeared,” he says.
“I wonder what ever happened to that plan?”